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IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company, Use:' Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number, WAIOPAEROAD ., City PAHOASWe HI ZIP Code 96778 I Company.NAIC Number I Efty both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments THE BENCH MARK USED IS A SURVEYOR SET BEANCH MARK BASED ON A USGS BENCH MARK. THE EQUIPMENT CONSIS OD A HOT WATER HEATER, A SMALL COMPRESSOR AND THE CONTROLS FOR THE AEROBIC SEPTIC SYSTEM AND NORMAL KITCHEN APPLIANCES SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items Et -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rim only, enter meters. Et. Provide elevation Information for the following and check the appropriate boxes to show whether the elevation Is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is — _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (Incuding basement, crawlspace, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6.9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8.9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ ❑ feet 0 meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is — _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building Is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or ownel's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Signature um Date btate ZIP Code Telephone The local official who is authorized by low or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. G1. ❑ The information In Section C was taken from other documentation that hes been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located In Zone A (without a FEMA -Issued or oommunity-issued OFE) or Zone A0. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. Permit Number I G5. Date Permit Issued I G6. Date Certificate Of G7. This permit has been Issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: — _ ❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: _ _ ❑ feet ❑ meters (PR) Datum G10. Community's design flood elevation _ _ ❑ feet ❑ meters (PR) Datum The Department nf Pr,611e Works Local Official's Name Engineering Divitiorr has reviewed Tine Community Name theXlevation Cartifiecie and Telephone does rot approval FEMA Forn', F 1-31, Mar 09 Check here If attachments Replaces all previous editions